Night Terrors in Children: Signs and Treatment

You get woken up in the middle of the night by the piercing scream of your toddler. What could be wrong? As you rush to their room, your mind races through the various possibilities. Did he fall from his bed? Did she have a terrible nightmare? Our children draw our protective instincts out whenever they seem to be under threat.

You do not want to cross a momma bear if she feels that her child is in danger. Parents and caregivers will do whatever it takes to alleviate the suffering or distress of their loved ones.

When it comes to night terrors, many parents and caregivers are left at a loss, and they feel powerless to do anything. Night terrors (also called sleep terrors) can be terrifying for parents as well, but this article will help you to navigate the signs of night terrors, and the various ways you can help your child.

What are night terrors?

There are two main types of sleep – non-Rapid Eye Movement (non-REM) and Rapid Eye Movement (REM) sleep. Dreams typically occur during REM sleep, while night terrors happen during non-REM sleep, around ninety minutes after a child falls asleep.

Night terrors tend to run in families, and they are a form of sleep disruption that seems like a nightmare, but it is far more dramatic. Night terrors are episodes of intense screaming, crying, thrashing, or fear during non-REM sleep that occur in children aged three to twelve, though they have been reported in babies as young as eighteen months. The child who has a nightmare will typically remember it, but one who has night terrors will often not recall the episode the following morning.

You might have a hard time waking your child during a night terrors episode, which can add to the distress a parent feels. Night terrors are relatively rare – they happen in only about six out of one-hundred children, and while both boys and girls of all races are affected, they seem to be a little more common among boys.

Even though night terrors can be distressing for a parent who witnesses them, they’re not usually a cause for concern or a sign of deeper medical issues that need to be addressed. Most children outgrow sleep terrors by their teenage years.

Signs of night terrors

A nightmare and night terrors are similar, but they are also quite different from one another. One of the major differences is that children normally recall their nightmares, and when they wake up from them, they are aware that they were dreaming.

During night terrors episodes, a child may sweat, breathe rapidly, and have a racing pulse, dilated pupils, and flushed face. While most night terrors episodes last for only a few minutes, it may take upwards of thirty minutes before the child manages to relax and go back to sleep.

Other signs to look out for include:

• screaming or shouting
• the child sitting up in bed and appearing frightened
• they may be hard to awaken and be confused if awakened
• staring wide-eyed but not really seeing anything
• they will have little or no memory of the event the next morning
• not talking when spoken to
• they may be unaware of your presence or efforts to soothe them
• flailing around in bed, or kicking and thrashing about
• they may be inconsolable and non-responsive to comfort

Waking a child when they have night terrors may be difficult. They are unlikely to respond to your words of comfort, and they may even push you away if you try to help them.

It’s important to remember that even though the child’s eyes are open during night terrors, they are not fully awake, and if they do wake up, they are more than likely to be confused and may not know what is happening to them. Don’t try to wake your child up during night terrors episodes, and if you can, just hold them and try to soothe them.

What are some of the causes of night terrors?

Sleep terrors are classified as “parasomnia,” an undesirable behavior or experience during sleep. Sleep occurs in several stages, and we typically dream during REM sleep, while night terrors happen during deep non-REM sleep. A night terror isn’t a dream – it is more of a sudden fear reaction that happens during the transition between sleep stages, typically between the deepest stage of non-REM sleep to lighter REM sleep.

It’s been discovered that a large majority of children who have night terrors have a close relative that also had night terrors, leading to the suggestion that there is a genetic component to night terrors. Several environmental factors can contribute to sleep terrors, such as:

• Sleep deprivation and experiencing extreme tiredness
• Stress, or feeling overtired, or ill
• Sleep schedule disruptions, such as when one is traveling
• Fever
• Depression or anxiety
• Too much caffeine
• Lack of sleep
• Sleep problems such as sleep apnea
• Taking a new medicine, or taking medications that affect the central nervous system
• Having received anesthesia recently for surgery
• Sleeping in a new environment or away from home

How to help your child

While night terrors can be very upsetting, the best way to handle night terrors is to wait it out and make sure your child doesn’t hurt themselves or anyone else. It may be tempting to get your child to wake up, but it’s best not to try to wake kids during night terrors. It doesn’t typically work, and even if it does, your child will likely be disoriented and confused, taking longer to settle down and get back to sleep.

While there is no treatment for night terrors, you can help prevent them and minimize the risk of harm. You can:

Reduce your child’s stress. Identify what stresses your child out, and brainstorm ways to handle the stress. If your child seems anxious or stressed, talk with them about it, and seek the help of a mental health professional where needed.

Create a bedtime routine that’s simple and relaxing. Make the bedroom a comfortable and quiet space for sleep. Do quiet, calming activities before bed such as reading books, doing some puzzles, or having a warm bath. Avoid electronics or activities that hype your child up at least a few hours before bedtime.

Make sure your child gets enough rest. Fatigue is a contributing factor to sleep terrors. You can try an earlier bedtime and a more regular sleep schedule. Sometimes a short nap earlier in the day may help them get the rest they need. If possible, avoid sleep-time noises or other stimuli that might interrupt sleep, and don’t let your child stay up too late

Make the environment safe. To help prevent injury, you can block doorways or stairways with a safety gate; remove any electrical cords or other objects that pose a tripping hazard; place any sharp or fragile objects out of reach and avoid using bunk beds if possible.

You can also look for patterns in your child’s night terrors. Keep a sleep journal, and if your child has night terrors around the same time every night, you can try waking him or her up about 15–30 minutes before then to see if that helps prevent it. Anticipatory waking can help to reduce the number of incidents of night terrors.

When to see someone about night terrors

Sleep terrors aren’t usually a cause for concern, but you should consult your doctor if sleep terrors are routinely disruptive, become more frequent, result in daytime sleepiness, continue beyond the teen years, or if they lead to safety concerns or injury.

Treatment for infrequent sleep terrors isn’t usually necessary, and it generally focuses on promoting safety and eliminating any causes or triggers. Treatment will typically address any underlying medical condition, address stress, or any causes of anxiety, and in very rare circumstances medications such as benzodiazepines or certain antidepressants may be useful for addressing night terrors.